Wednesday, November 9, 2011

Take Me Out to the Ball Game

The role of the ED physician has dramatically evolved over the last 10 years. The perfect ED provider must be a combination of Dr. Marcus Welby from ABC’s 1970’s hit show, Dr. Leonard “Bones” McCoy from Star Trek, and the staff from the 90’s TV show ER.  Doctors are expected to be good-looking, decisive, charming, and always get it right in the end – all in less than 48 minutes (barring extra commercials.

This is obviously a difficult task for us mere mortals. The present model has the physician perform every role for every patient. Assigning a provider to the intake (formally known as triage) has started to break down the classic role.

To take this concept one step further ED staff members can be broken down to using a sports analogy –a baseball team.
  • Starting pitcher—triage—get the ball rolling—start the evaluation ASAP
  • Middle relief—fully evaluate the patient and develop treatment plan
  • Long relief—on call to deal with massive volume shifts
  • Closer—makes the final compact with patient, family, admitting physician, consultants in a very timely manner.
  • Designated hitter—provides critical care to free up rest of staff
  • Manager—medical director guiding flow and dispute resolution
  • Broadcaster—public relations specialist in Press-Gainey and PRC scores
  • Statistician—documents all the data for medical-legal, reimbursement, and time frames.
  • Rest of Team—The key to success is the support staff - nursing, administration, trainers, secretarial staff, etc.

In conclusion—a single provider even with an all-world team members is hard pressed to perform all these tasks.

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